Hang together or hang separately…. Working in partnership to develop palliative care -Jairam Kamala Ramakrishnan

Categories: Featured, Leadership, Opinion, and People & Places.

Last year as the pandemic raged across the world, I was involved in a situation assessment of palliative care by WHO in the South East Asia Region (SEAR). Working remotely had become norm and I had a chance to talk to leading palliative care practitioners across the region. SEAR comprises Bangladesh, Bhutan, DPR Korea, Indonesia, India, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. Of these, most countries have at least some palliative care services, a few are expanding services nationally and a few have just fledgling pockets of care.

Palliative care was thrown asunder with some teams feeling crippled by social restrictions and some teams pulled in to bewildering communication challenges within dystopian hospital settings.

Within this space, I heard from professionals and volunteers about palliative care journeys in their region. It cannot be denied that significant progress had been made across the SEAR. However, in the midst of all the frenetic activity across public, private and voluntary sectors, what was conspicuous by its absence was a joined up and coordinated action across these sectors.

Despite the tireless work done by NGOs and sometimes single individuals across the region, in terms of scale and coverage, nothing seemed to match focused governmental action. Success of governmental action appeared to be from high level policy backed by committed funding, Thailand being a case in point. Even in the absence of government led initiatives, consistent engagement with a bureaucrat sympathetic to the cause yielded gains for NGOs in advancing palliative care.

  Thailand Home Care 

At one extreme, there were NGOs pleading for governmental commitment and action. Yet at the other end, there were government health systems bringing much needed advances where practitioners felt stifled- innovation and flexibility were perceived as limited by regulations and resource shortage.

Across the region, even in vibrant palliative care services, community partnership although universally accepted as a very good idea, was rare in practice.

The need for communities, health care providers, professionals and government to join hands is clear and pressing. Partnership work is challenging as it is influenced by cultural characteristics of communities and bureaucratic traditions of governments. In addition, most health professional training does not equip practitioners to work in partnership with communities.

As the world works towards the goal of Universal Health Coverage, multi-sector collaboration is a requirement rather than just a good idea. Hanging together is imperative.


Jairam Kamala Ramakrishnan  is a psychiatrist with interest in palliative care and public health.


  • Honorary Consultant at Institute of Palliative Medicine, Calicut
  • Honorary Senior Lecturer in Psychological Medicine, University of Auckland

Lead Image: Palliative Care Assistants Bangladesh

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